June 29, 2011

Disease Eradication and the Role of International Organizations

Yesterday, the United Nations announced that, for only the second time in history, a disease has been successfully eradicated from the Earth. The offending affliction in question, which strikes animals—particularly cattle—is called rinderpest, and its lethal effects have disrupted and plagued human society for thousands of years. As The New York Times put it, rinderpest has “been blamed for speeding the fall of the Roman Empire, aiding the conquests of Genghis Khan and hindering those of Charlemagne, opening the way for the French and Russian Revolutions, and subjugating East Africa to colonization.” The UN moved to coordinate and promote the worldwide effort under the Global Rinderpest Eradication Programme (GREP) in 1994. GREP’s goal, from the outset, was to eliminate the disease’s circulation in its natural habitat by 2010. The successful effort raises an obvious question: Could similar mechanisms be employed in other eradication efforts?

Scholarly research suggests that global institutions aren’t just preferable—they’re probably necessary. In a 2003 paper called “Global Disease Eradication,” Scott Barrett, then of Johns Hopkins University, notes that most eradication efforts have failed. (In fact, up to that point, the only successful such effort was against smallpox.) The high rate of failure is due, in part, to disease eradication’s status as a worldwide public good, meaning that it’s not just a public health issue; it’s an economics problem as well. As Barrett argues, “When the last country eliminates the disease, it eradicates the disease globally, and yet the last country will only take into account the benefit of this action for itself.” Worse still, according to Barrett, is that “as other countries eliminate the disease, the risk of infection in the last country is reduced by the externality of herd immunity, making elimination by this country even less attractive.” In other words, as health officials get closer and closer to the goal, countries have decreasing incentive to do their share in the work of eradication. This analysis, Barrett writes, “suggests that eradication will sometimes require very strong international institutions.” Indeed, the lack of strong international cooperation nearly derailed the eradication of smallpox. The initial vote in the World Health Organization to provide modest funds for eradication almost failed, and eradication efforts were continually plagued by countries failing to provide adequate funding. With that near-miss in mind, the GREP model seems to offer a promising alternative—one which may be crucial in future eradication efforts.